The Approach focused on Behaviour Change Determinants (ABCD) is a socio-anthropological approach based on the study of behaviours and their determinants to help humanitarian and development actors design relevant and sustainable WASH interventions. It targets the most problematic practices in a community by using the most effective determinants to generate a positive change in the community’s behaviour.

ABCD should be integrated into the assessment (chapter  A ) and design stages of the project cycle. The assessment phase, in particular, is supported by the use of qualitative and quantitative data and participatory tools enabling the triangulation of information and engagement of the target communities to develop an appropriate operational strategy. During the assessment, the first objective is to identify, quantify and prioritise the WASH behaviours that pose a risk to the community’s health. Secondly, the psychological, socio-cultural and environmental determinants that favour or prohibit target WASH practices must be identified and ranked and the most effective determinants selected to change those practices. Although the methodological framework of the ABCD approach has been formalised, it remains flexible and can be adapted to various intervention contexts. It targets five key hygiene-related behaviours that have the most impact on diarrhoeal diseases (1) washing hands with soap, (2) adopting appropriate defecation practices, (3) keeping the latrines and dwelling areas free from excreta, (4) providing clean drinking water and (5) safely collecting, transporting and storing drinking water. However, other behaviours can be integrated into the approach if there is solid evidence to show they also have a significant impact on diarrhoeal risks.

Tools and Methods used

Tools for identification of behaviours and their determinants

• Literature review
• Immersion and Observation T.28
• Focus Group Discussion T.14
• Community Mapping T.7
• Transect Walk T.52
• Historical calendar and Seasonal Calendar T.43
• Classification of well-being (to identify social dynamics)
• Gender Analysis T.16

Tools linked to health determinants (fear of disease, perceived health etc.)

• Ranking T.39
• Disease perception matrix
• The game of risk

Tools linked to economic determinants 

• Expenditure priority tools 

Tools that enable exploration of behaviours and practices (including levers and obstacles)

• Water source perception matrix
• Pocket Chart Voting T.31
• Behaviour/practice matrix
• Household Visit T.18 including individual interview guide

Determinant comparison tools

• Doer/Non-Doer Analysis T.32
• Classification cards

Others

• ABCD staff training curriculum

Applicability

The considerable amount of time required to implement ABCD makes it unsuited to an acute response phase. The approach is better suited to recovery and development interventions and can be used in rural, peri-urban and camp contexts. The approach requires prior training. It is helpful to use ABCD from the start of a project to maximise its potential. The approach covers a significant proportion of hygiene-related issues. This can be a strength but is also a weakness, as the issues need to be studied simultaneously and can lead to the need for multiple interventions at one time. 

Main Requirements / Investments Needed

An ABCD team usually includes one project manager, one activities manager and several interviewers or awareness-raisers. The ABCD approach takes between 30 to 100 days and consists of one day for team training, four to six weeks for data collection, two to four weeks for data analysis and designing of the operational strategy, half to one day for team training on each implementation activity and at least one week for piloting. Staff must also be trained to implement the ABCD. 

Evidence of Effectiveness

The behaviour change principles of ABCD have a solid scientific foundation and draw on health and social psychology research. It is also aligned with RANAS F.20 and Evo-Eco models of behaviour change (see [references]). Although no large-scale evaluation has been conducted to measure its effectiveness, short-term Monitoring M.2 and Evaluation M.3 activities in the Central African Republic and the Democratic Republic of Congo showed a positive impact on hygiene behaviours. 

Do

• Use the ABCD approach from the beginning of (and throughout) a WASH project 

• Make sure all staff have understood the approach and its principles

• Identify communication channels or points of interaction with the community to complement the ABCD approach

Don't

• Do not skip any phases in the approach to save time as it may result in poor context analysis 

• Do not ignore the importance of WASH infrastructure to enable change in conjunction with other determinants

Practical Example

ABCD was implemented in 2014 in a peri-urban neighbourhood of Kinshasa and three neighbourhoods in the Bas-Congo region in the Democratic Republic of Congo. The key behaviours targeted by the approach were ‘keeping the latrines free from excreta’ and specific behaviours for children under-five. The key determinants of practices were knowledge (about the contamination of waterborne diseases), prestige (of having a clean latrine), disgust (of excreta and dirty water), maternal love (prioritising the health of the child), fear (of waterborne diseases), habit (of collecting dirty water and washing hands in a communal basin), access (to a source of drinking water and a handwashing facility) and economics (cost of illness versus the cost of soap). Three strategies for three neighbourhood profiles were designed. The approach targeted mothers and fathers of children under five (fathers were often involved in latrine maintenance). The selected communication channels were Household Visits T.18, posters T.19, video projections T.6, Radio T.38 and local leaders T.22.